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Johannesburg - When dying Zambian president Michael Sata flew to London last week he was following a long line of African leaders who have sought emergency - and secret - medical treatment in foreign hospitals most of their citizens can only dream of.

With Ebola exposing the poor state of the continent's healthcare systems, and mobile phones and social media undermining official attempts to control and suppress information, many Africans were unimpressed.

After Sata's death on Tuesday evening, websites lit up with angry comments about another ailing African head of state jumping on a plane rather than risking being patched up in one of his own hospitals.

"Sadly, his death has added to the long list of rich and influential Africans to die while on medical tourism in Europe and America," a commentator called Striker wrote on the website of Nigerian newspaper Punch.

For those in Zambia, a vibrant and relatively stable nation of 13 million people that has recently enjoyed annual growth around 7%, the sense of hypocrisy is particularly acute.

Sata's predecessor-but-one, Levy Mwanawasa, died in office in Paris six years ago after suffering a stroke in Egypt, and one of Sata's many 2011 election promises was to improve public infrastructure, including healthcare.

However little changed on the ground, and when Sata's son, Kazimu, was involved in a car smash in the northern town of Ndola in July he was taken by air ambulance to Johannesburg's Milpark hospital, a world-class private facility in South Africa.

Kazimu's fellow passengers had to make do with the Ndola General, according to local media reports.

"What if we had a situation where the children of our politicians were obliged to receive their care in Zambian hospitals?" Zambia Reports, an anti-government news website, asked in an editorial at the time.

"No doubt we would begin to see immediate improvements to the training, equipment, funding, and innovation of healthcare facilities throughout the country."

DOA

With the exception of South Africa - home to top-notch hospitals and the world's first human heart transplant in 1967 - few sub-Saharan governments are willing to let their leaders get much more than a cough on home soil.

They are also loathe to tell their citizens, frequently playing down the seriousness of medical problems or denying them altogether - one reason for the "mystery" or "undisclosed illness" that claims so many of Africa's 'Big Men'.

Ethiopian strongman Meles Zenawi died aged 57 in a Belgian hospital in 2012 after top government officials insisted for more than a month he had only a minor illness and his condition was not serious.

In Nigeria, Africa's most populous nation and its biggest oil producer, President Umara Yar'Adua had months of heart treatment in Saudi Arabia before returning home in 2010 in almost total secrecy and dying after weeks on life support.

Africa's oldest leader, 90-year-old Zimbabwean President Robert Mugabe, regularly flies to Singapore for what officials say are "routine" eye tests, although given his age and persistent cancer rumours, few of his countrymen believe them.

Besides the health benefits, parking an ailing leader abroad far from prying eyes lets first families and the inner circle control the flow of vital information, an important weapon in the succession battles that inevitably follow in a continent of fragile democracies.

Few cases beat that of Malawi president Bingu wa Mutharika, who was dead on arrival at a Lilongwe hospital in 2012 after a massive heart attack, only to be flown in secret on a chartered jet to South Africa for "medical treatment".

Power struggle

In the meantime, there were fears of a seizure of power as cabinet members - including Mutharika's brother - met without vice-president Joyce Banda, who was only named as the constitutionally approved successor after the intervention of the head of the army.

In case of Sata, who had no clear successor, the government also went to great lengths to prevent media coverage of his health and absence from the public eye since June.

However the strategy failed as dissident news websites such as Zambia Reports and Zambian Watchdog, run by an exile in London, emerged as the main sources of information on the only topic in town.

"The Zambian case has been fascinating because there has been such a crackdown on the formal media reporting on the health of the president," said Grant Masterson of the Johannesburg-based Electoral Institute for Sustainable Democracy in Africa.

"It had been an open secret for a while. Zambians were all talking about the health of their president even though they weren't allowed to read about it in their papers."

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